Free clinics in a post-Obamacare USA

With the Supreme Court’s June decision to uphold most of the Affordable Care Act, there has been a firestorm of emotional reaction from both critics and supporters of the bill. Critics have called it a big government takeover of our healthcare. They falsely claim that the United States has welcomed socialized medicine into our country. This is nothing more than fear mongering by the people on the right who would say anything to have President Barack Obama defeated in November.

But the more dangerous attitude, I believe, comes from the bill’s most passionate supporters. Among this group, there are many people who see healthcare reform as a checked box, a fait accompli. They believe that President Obama and his Democratic supporters have “done healthcare reform.” But this kind of thinking overlooks the massive gaps in the bill and threatens to render the nation passive and unwilling to tackle the huge issues that remain in our healthcare system.

The bill’s most pressing moral shortcoming is the fact that it will leave 23 million Americans without healthcare insurance, an improvement from the current level of 53 million uninsured, but far from universal coverage. The United States is and will remain the only industrialized nation in the world that lacks universal health insurance coverage.

Therefore we have not “done” healthcare reform. We have simply taken a first step. There is still a role for charitable groups and free clinics to provide healthcare to those who still fall through the cracks of reform.

Furthermore, we must note that there is a difference between healthcare coverage and healthcare access. Coverage simply refers to enrollment in some form of insurance plan. Access means the ability to get necessary and desired medical treatment. The difference is subtle but important. Bill Gates has healthcare coverage, and so does a poor, single mother of three who is on Medicaid. But because many doctors refuse to see Medicaid patients, being on Medicaid does not mean that you have access to healthcare. Bill Gates’ healthcare plan provides him with far better access than any Medicaid plan.

While the Affordable Care Act expands coverage, it remains to be seen how much access will be expanded.

I am the founder and president of CareFree Clinic, a Brown service group whose aim is to expand access to healthcare in Rhode Island. We do so by providing free health screenings around the Providence area and by referring needy patients to a free clinic for the uninsured.

To give you an idea of the lives of some of our patients, I’d like to tell the story of a Pawtucket resident who came into one of our screenings. This man, 25 years old and single, makes just enough money to be ineligible for Medicaid but not enough money to buy his own healthcare insurance. He works 50 hours a week for a small company that does not offer health insurance to its employees. Even with Obamacare, there is a chance that he will remain uninsured for the foreseeable future.

He told one of our volunteers that he had been feeling dizzy and feared he had diabetes. We tested his blood sugar and found it to be extremely high – far above the normal level. This man was in vital danger and we got him an urgent appointment at Clinica Esperanza, our free clinic partner. Fortunately, the doctors and nurses at the clinic were able to stabilize his sugar level before he slipped into a diabetic coma and died. But how many people like this are out there, on the verge of a catastrophic medical emergency because they can’t afford to see a doctor regularly? How many of them will continue to slip through the cracks, even after full implementation of the Affordable Care Act is achieved? How many people will die or go bankrupt each year because they cannot afford the care that they need?

The reality is that until truly universal access is achieved, we still need free clinics as gap fillers. CareFree will continue to funnel patients from our screenings to Clinica Esperanza, but the reality is that Clinica Esperanza cannot meet the needs of the entire state. There is also Rhode Island Free Clinic, but they too are constantly inundated with patients.

We need to continue to support our free clinics. They are doing heroic work, and they will continue to be necessary long after the Obamacare debate has ended.

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